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Part 2 of Eamonns piece on Midazolam looking particularly on how to administer the drug when a seizure occurs,.

Posted by Eamonn Brady on

Buccal Midazolam Directions (Quick-Guide)

For Epileptic Seizures (Part 2)


This is a continuation of last week’s article on Buccal Midazolam which is prescribed to treat some epileptics who have a history of longer seizures known as Status epilepticus. As discussed last week, for this indication the midazolam solution is administered against the sides of the gums and cheek so that the medicine is absorbed directly into the bloodstream. This is known as the buccal or oromucosal route.


When to administer?

The instructions I have below for when to administer the first and second dose is the general guidance; for specific patients their doctor may have slightly different guidelines of when to administer so if you or someone are prescribed buccal midazolam, it is important to communicate this to everyone likely to have to administer for you at some stage (eg) family, friends, workmates


1st Dose: Administer if a seizure lasts for five minutes (as the majority (75%) of seizures will expire within five minutes and buccal midazolam may cause severe drowsiness)


The dose for children over 10 years and adults is 10mg (1ml). For younger children, doses come in 2.5mg, 5mg and 7.5mg; administer the dose the doctor prescribes


2nd Dose: For adults (and some children), a second dose may be given 10 minutes later if no response is apparent and the patient is breathing normally. If the patients’ breathing becomes shallow, call an ambulance and do not administer a second dose. If a response is not seen after a further 5 minutes, call for assistance. Ambulance staff may repeat the dose if deemed appropriate.


What to do if a seizure starts again: Generally a 3rd dose is not advised without medical supervision. An ambulance should be called if seizures continue. The maximum recommended dose in 24 hours is 20mg for adults (or less for children). Please follow the advice given by the initiating specialist.


What are the side effects of buccal midazolam?

  • Drowsiness and sedation – recovery is usually fast.
  • Amnesia or short-term memory loss – the person may not remember having had a seizure.
  • Breathing difficulties – the person is unlikely to have breathing difficulties if midazolam is given at the correct dosage. If breathing difficulties do develop, seek medical assistance.
  • Restlessness, agitation and disorientation – these can occur but are usually rare.



Keep midazolam at room temperature (not in a fridge). Store away from bright light or direct sunlight and away from heat. Always double check expiry date (written on side of pack) and get a replacement prescribed by your GP if nearing expiry.


Free Demonstration

If you would like pharmacist Eamonn Brady to give you a demonstration how to administer buccal midazolam, email Whelehans at to request. There is no charge for this demo. If you need a demo for a few people, Eamonn can call out to your place of work/ residence to give a demo at no charge.


Disclaimer: This is a general guide; individual patients will have more specific guidance depending on their type of epilepsy and seizure history. Always follow the prescribing doctor’s advice. If a person is prescribed Buccal Midazolam, it is good practice to have written administration instructions or protocol specific for that patient (eg) When to administer? Can a 2nd dose be administered? After how long?


For health advice and information call in to Whelehans Pharmacies, log on to or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).

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